HomeMy WebLinkAbout10-30-14 IN RE: : ORPHANS COURT DIVISION
ESTATE OF BETTY L. ADAMS, : COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY
: PENNSYLVANIA
LATE OF TOWNSHIP OF MIDDLESEX : WILL NO. 2014-00065
: ADMIN. NO. 21-14-0065
AFFIDAVIT OF SERVICE
AND NOW, this��day of � , 2014, comes Bradley L. Griffie,
Esquire, and states that he mailed a copy of a Petition to Make Rule Absolute to the
Respondent, Department of Public Welfare, Attn: Tina M. Wise, at her address of
Division of Third Party Liability, Estate Recovery Program, P.O. Box 8486, Harrisburg,
Pennsylvania, by certified mail, return receipt requested. A copy of said receipt is
attached hereto indicating service was made on October 24, 2014.
B• . G iffie, Esquire
,, rney for Petitioner
� Supreme Court ID# 34349
GRIFFIE AND ASSOCIATES, P.C.
200 North Hanover Street
Carlisle, PA 17013
(717) 243-5551
(800) 347-5552
Sworn and subscribed to
before me this��_day
of ����,� , 2014 �
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ROBI�I�;.�ASSETT,Notary Public :.� J -,
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■ Compiete items 1,2,and 3.Also complete a. signature
item 4 if Restricted Delivery is desired. X �� �,,,0/�} ❑Agent
A Print your name and address on the reverse ��'Pl�dtlressee
so that we can return the card to you. B. Received by( ri �ate of De ivery
■ Attach this card to the back of the mailpiece, ; � 20�
or on the front if space permits.
D. Is delivery address different from it�irl? d Yes
1, Article Addressed to: If YES,enter delivery address belaW"� ❑No
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2. ArticleNumber 7p12 346� aoa2 1544 ��'.�99
(Transfer from servlce labeq �"
PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M•1540